Air embolism is a serious complication of central venous catheters that occurs when air enters the vasculature through an open catheter lumen or insertion site. Symptoms include cyanosis, respiratory distress, and hypotension. Treatment involves giving 100% oxygen and placing the patient on their left side to displace air from the heart. Prevention strategies include using luer-lock connections, avoiding tubing loops, covering sites after removal, and having patients hold their breath during catheter removal.

1. Air embolism is one of the most serious
complications associated with central
venous catheters. This occurs when air
enters into vasculature through an open
central venous lumen/catheter or
through the insertion site of the CVC if
it is not properly covered after CVC
removal

2. O Air embolism from CVC occur when the
negative intra-thoracic pressure created
during inhalation sucks the air through the
opening of CVC or CVC insertion site into
the circulation. This air then travel towards
the heart and may become trapped in the
right ventricular outflow tract. Right side
of the heart will be unable to pump blood
into the lungs.

3. Signs and symptoms
1. Cyanosis
2. Respiratory distress
3. Hypotension
4. Petechiae
5. Feeling of impending doom
6. Gasp reflex (automatic response as a result of
hypoxemia)
7. Cardiac arrhythmias
8. Loss of consciousness and neurologic deficits
9. Elevated CVP and pulmonary artery pressure
10. Mill wheel murmur

4. The 2 most prominent signs associated with
large venous air embolism are
O Gasp reflex
O Mill wheel murmur
Mill wheel murmur is a continous, loud,
churning, drum like cardiac murmur caused
by a right atrial and right ventricular outflow
obstruction. It is heard over the precordium.

5. Treatment involves administering 100%
oxygen and placing the patient on the left
side with the head downward (left lateral
trendelenburg position).
This position displaces the air from the right
ventricular outflow tract to the apex of the
heart where it can be either resorbed or
aspirated.

6. Prevention strategies
O Use only luer-lock connections on CVC
lumens.
O Avoid long loops on IV tubing
O Use screw caps on 3 way connectors
O Immediately cover the insertion site with
dressing after CVC removal
O Positions the patient supine, if not tolerated
semi fowlers position while removing CVC.
O Advice the patient to take a deep breath and
hold the breath at the start while removing the
CVC.